Oralair, Grastek and Ragwitek for Grass and Ragweed

Grass and Ragweed Sublingual Immunotherapy Tablets

Man taking a walk in the fall
Ragweed allergy can be treated with Ragwitek. Adam Crowley/Blend Images/Getty Images

Sublingual immunotherapy, or SLIT, is a form of immunotherapy that involves putting allergen extract under the tongue. SLIT can be taken in liquid form as drops, or in tablet form, and is becoming a popular alternative for allergy shots. This form of immunotherapy has been used for many years in Europe and other areas around the world, and was approved by the U.S. Food and Drug Administration (FDA) in 2014, at least in 3 different sublingual tablet versions to treat the symptoms or allergic rhinitis and allergic conjunctivitis.

Oralair and Grastek were approved for the treatment of grass pollen allergy, and Ragwitek was approved for the treatment of ragweed pollen allergy.  

Oralair, Grastek, and Ragwitek are all taken in the same fashion: The dissolvable tablet is placed under the tongue and allowed to dissolve. The person is asked not to swallow for at least one minute afterwards, and not to eat or drink for at least 5 minutes after that. These tablets are taken once daily, starting generally 3 to 4 months prior to the onset of the pollen season corresponding to the treatment in question – grass season often starts in April or May, and ragweed season generally starts in August, depending on the geographic location. The tablets are taken daily until the end of the pollen season, although in the case of Grastek, can also be taken continuously for a total of 3 years.

It is very important to realize that SLIT is not a medicine; rather, it works similar to a vaccine, and changes the way a person’s immune system reacts to allergens.

For this reason, it takes time to obtain benefit from SLIT, typically many weeks to even months. SLIT would not be expected to treat the immediate symptoms of allergies, but prevent those symptoms over time. For the immediate treatment of allergy symptoms, a person would need to take a medicine such as an oral antihistamine or nasal antihistamine spray.

Find out how SLIT works to treat allergy symptoms.

Oralair for the Treatment of Grass Pollen Induced Allergic Rhinitis

Oralair is a mixture of five different grass allergens in a single sublingual tablet that is indicated for the treatment of grass pollen allergic rhinitis and allergic conjunctivitis in people 10 to 65 years of age. The manufacturer recommends that Oralair be started 4 months prior to the grass pollen season and taken every day until the grass pollen season is over. Multiple studies on hundreds of people using Oralair showed that allergy symptoms and medication use decreased on average 50% when compared to those receiving placebo. Common side effects included throat irritation and swelling, mouth and ear itching, and coughing. While most of these side effects were mild, 0.1% of people experienced a severe allergic reaction resulting in the need to stop treatment with Oralair.

Grastek for the Treatment of Grass Pollen Induced Allergic Rhinitis

Grastek is timothy grass allergen in a sublingual tablet that is indicated for the treatment of grass pollen allergic rhinitis and allergic conjunctivitis in people 5 to 65 years of age.

The manufacturer recommends that Grastek be started at least 12 weeks prior to the grass pollen season and taken every day until the grass pollen season is over. Alternatively, Grastek can be taken continuously for three consecutive years. Multiple studies on hundreds of people using Grastek showed that allergy symptoms and medication use decreased on average 20-35% when compared to those receiving placebo. When taken daily for 3 years, the benefits of Grastek continued for an additional grass pollen season after stopping the therapy, but not during the second grass pollen season after stopping the therapy. Common side effects included throat irritation and swelling, and mouth and ear itching. While most of these side effects were mild, 0.4% of people experienced a severe allergic reaction resulting in the need to stop treatment with Grastek.

Ragwitek for the Treatment of Ragweed Pollen Induced Allergic Rhinitis

Ragwitek is ragweed allergen in a sublingual tablet that is indicated for the treatment of ragweed pollen allergic rhinitis and allergic conjunctivitis in people 18 to 65 years of age. The manufacturer recommends that Ragwitek be started at least 12 weeks prior to the ragweed pollen season and taken every day until the ragweed pollen season is over. Multiple studies on hundreds of people using Ragwitek showed that allergy symptoms and medication use decreased on average 17-45% when compared to those receiving placebo. Common side effects included throat irritation and swelling, mouth and ear itching, tongue itching and numbness in the mouth. While most of these side effects were mild, 0.1% of people experienced a severe allergic reaction resulting in the need to stop treatment with Ragwitek.

While the currently available sublingual tablets are only effective for people with grass and ragweed induced allergic rhinitis and allergic conjunctivitis, I would expect that tablets for cat dander and dust mite allergy would be available in the future. Beyond those allergens, which are standardized on the major allergen content, it is unlikely that other allergens will become available in sublingual tablets. However, many allergists offer sublingual drops, which are currently not FDA approved to be given under the tongue (they are approved to be injected as a shot), as a way to treat allergies caused by a wide variety of other pollens, mold spores and animal dander.

What should you choose to treat your allergies? Allergy shots or drops?

Sources:

Oralair Package Insert. Accessed September 29, 2014.

Grastek Package Insert. Accessed September 29, 2014.

Ragwitek Package Insert. Accessed September 29, 2014.

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